Happy Birthday, Sis

This past weekend it was my older Sister's birthday. This is particularly interesting for a few reasons:

1. She's pretty cool and very worthy of many fine birthday wishes. She's got two great children (and thus I have an awesome niece who is about to start middle school this week and I have a wildly creative 6-year-old nephew, too). She's a teacher's assistant working with severly handicapped children and she loves her job, and over the past year she has lost over 75 lbs on Weight-Watchers. I'm so proud of her I could spit.
   
   
2. When I say she's my "older sister" I say this in jest (though it's still a fact), as she's only 34 minutes

   Another true story

   Whenever I tell people that my sister and I are 34 minutes apart, most seem to think that that's a decently long interval between the birth of twins. I have no idea what the average length between the birth of twins is, but 34 minutes must be toward the high end. In fact, I recently found out 34 minutes was enough time for my mother get up, get out of the stirrups, go to the bathroom, and smoke a cigarette.
   
   I am told my father tried to dissuade her on the grounds that she wasn't allowed to smoke inside the hospital, but that these protests were ultimately futile.
   
   Though I love my mother dearly, I blame all my short-comings on this event.
   
   In my mother's defense, I'm going to assume that they didn't know back then just how bad it is to smoke during pregnancy. A few years ago I went to see "The Exorcist" (1973) in a theater and was shocked to see scenes of doctors smoking in hospitals. I also have a copy of "Extpectant Motherhood" published in 1952 (don't ask) that supports this less than stringent prescription re: pregnancy and smoking, and I quote:
   
   "While most obstetrical authorities, then, disapprove of excessive smoking in pregnancy (twenty-five or more cigaretts daily), there is no reason for believing that a woman who smokes moderately, let us say ten cigarettes or less a day, need change her custom at this time. If you have been used to smoking considerably more than this for several years, by no means try to give them up in pregnancy. There is no surer way of upsetting the nerves at a period when you should be calm and happy, or of converting a placid, sweet-tempered girl into an intolerable shrew. With negligible effort, even the most inveterate smoker can usually be content with a package a day or somewhat less, and if you arrange this there is no great cause for concern."
   
   I shit you not.
   
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   older than me.

Yes, we are twins. Way back when, when clomid was the bleeding edge of infertility treatments, we were conceived. As an adult with diabetes, I have given much thought to how indebted I am to modern advances in science, medicine, and technology. Without these advances, it is unlikely that I would have even been born, let alone survived past the age of 5! (And so I quote Kip: "Yes, I love technology").

To save some time, here are my pat answers to common questions about being a twin (you can fill in the questions as you see fit):

Q: ?
A: I don't know, it was fine, I guess. I don't really have an alternative to compare it to, really. What's it like growing up with an older/younger brother/sister? I bet THAT's really cool.

Q: ?
A: No, she doesn't have a beard.

Q: ?
A: No, I don't grow a beard so people can tell us apart.

Q: ?
A: We look about as alike as any other brother and sister would.

Q: ?
A: No, we're not identical (duh!), we're fraternal twins: that's two separate eggs, not one egg that has then split.

So she came down for a visit with my Mom and some close friends of the family, and we had a nice little birthday celebration at the ol' homestead with some other friends. 'Twas very nice.

And to put some proverbial icing on the proverbial birthday cake, I had my 2 month check-up with the opthalmologist. The doc made some statements like "this looks great" and "excellent" as he waved that bright little mirror of light in front of my eyes and asked me to look up, down, and to the left, and to the right. No new signs of capilary growth, just the remnants blood spots of the non-proliferative variety (which he said probably will not go away). Quite a relief. I go back in 4 months for another check-up and then I'll be on an "every-six-month" schedule.

77

Last night at 8:38PM I rang in at 77. This was just before driving home from the grocery store, so I stuffed a (strawberry) Nutri-Grain cereal bar in my mouth. When I got home, I had a late dinner of thin crust pizza (and a beer). Before going to bed, I was again at 77 (at 10:23PM) so I ate a few grapes before hittin' the hay. I was at 113 at 2:49AM (I rarely sleep through the night) and woke up at 130 at 7:30AM (I got to sleep in a bit today).

After some strange upward drift in the morning hours that I've been noticing lately, I ate breakfast (Giant brand Light Nonfat Yogurt: 20CHO) and was at 102 at 11:12AM AND THEN BACK at 77 at 12:16PM before lunch!

I love the Talking Heads.

Two Weeks

Yikes!

It's been two weeks since my last post. And while I've got some good excuses (and some not-so-good ones, too), excuses are lame, so I'll spare you. If I'd been keeping up with my writing/blogging, I'd have posted at least twice about 3 or 4 random topics. Here's my current brain-dump (sorry for the back-log).

Minimed CGMS^® System Gold™ (sic) Results

I got my CGMS results back two weeks ago, and although the sensor came out on me in the middle of the day Saturday, I did get a decent amount of data back. Overall, my control was pretty good and the docs were pretty impressed. It's certainly nice to know all my hard effort is worth it. There were a few spikes that I missed when I compared my 15-20 finger tests with the continuous monitor, but they were really few and far between, and not all that drastic. I wish I could share the data with you, but sadly, they only give you print copies of your data and I do not own a scanner (perhaps I'll ask Santa for one for my birthday).

I got to try out the System Gold™ because a Research Fellow (who is actually not a "fellow" in the "fella" sense of the word; she's a she and to avoid confusion (mostly on my part as I'm writing this) I'll refer to her as Dr. H.) was organizing the trial / event / I don't know what to call it and my endocrinologist, Dr. A (also a she), gave her my name as someone who might be interested in participating (which, obviously, I was).

When the data came back, I first met with Dr H. and then aferwards, Dr. A. came in and joined us. Dr. H.'s only suggestion was that I could try lowering some of my carb ratios just a bit or work a little harder on my carb counting to try to tame some of my post-prandial spikes. As I eat almost the same breakfast and lunch everyday and have the carbs pretty accurately counted for those meals, I tried some lower carb ratios over the last few weeks. After having several predictable and consistent lows, I have adjusted them back to be almost where I was before.

	My Carb Ratios
	Before	Last week	Now
Breakfast	10:1	8:1	9:1
Lunch	12:1	10:1	12:1
Dinner	12:1	10:1	11:1

So, as you can see, not a lot of change, but some fine-tuning for sure. And fine-tuning is where it's at these days for me. I'd definately say the motivation coupled with some empirical evidence to make some minor adjustments was well worth the aggrevation of wearing that bulky monitor for a few days.

And then Dr. A. came in and joined us. She was perky and said "See! I told you so!" a lot. And as I was looking at some of the graphs from the sensor, she nonchalantly leaned over an put a quick little "X" over a spike on the graph I was looking at on my lap, all while talking about something else, and I don't even think to me. I'm sure she doesn't realize that a quick, judgemental, flick of the wrist, can be so insulting, but oh was it ever. And as I walked out of the office a few minutes later, I realized that she had stolen my pen.

Travels

Last weekend I flew from DC to Detroit and back to go to a wedding in Kalamazoo, MI. In the past two years or so, I've flown to Costa Rica, San Antonio, TX, and Portland, ME. At each-and-every leg of each trip I have been "randomly selected" to be searched. Whenever I complain about this, the person I'm complaining to inevitably says: "I bet it's because of your beard." It is Not because I have a beard. After I realized there was a pattern here, I found that there's actually been a little code on my boarding pass indicating that I was to be screened. I've said to myself (and out loud to others) that I'm going to contact the United / Delta / US Airways or whoever it was I was flying with to see why I'm always selected for a screening and whether I can get my name OUT of their database. Since I fly so infrequently, however, I have never actually done this.

So I'm preping to travel a day after all the hoopla in London, and I've torn off the bits of my insulin boxes with my name on the prescriptions and added that with the letter I have (from 2002) from my doctor kindly explaining that I have diabetes and that I need to have my insulin and various lancets, needles, meters, and assorted devices with me on the flight in my dopp kit.

To my utter surprise, I was not "randomly selected" to be screened, but the x-ray did find my diabetic supplies and my bag was thoroughly searched. Based on previous experiences, the only difference between being "randomly selected" for a screening and having the x-ray find syringes in your bag, is that you get to keep your shoes on, you don't have to take your belt off, and you don't get patted down and having some man run his hands inside your waistline.

Each way, the "Homeland Security Agent" was kind and even apologetic when I explained that I was diabetic and had insulin in a frio pack to keep it cool. And one of them was more interested in the zip-lock bag of wasabi peas I had with me than in any of my assorted needles or vials of insulin.

While the wedding was nice (as nice as can be when you don't know anyone there (it was for a childhood friend of my wife's, whom I've only met once before (the friend of my wife, that is))), and I had a great conversation with the father of the bride about diabetes drug research (he's starting his own company based on a drug he discovered several years ago for some type II diabetes treatment), there aren't many nice things I can say about Kalamazoo. But there is one: if by some unfortunate stroke of luck you find yourself in Kalamazoo, I can *highly* recommend stopping at Bell's Brewery. It's got a completely drab, industrial looking exterior and is located next to some railroad tracks, which made me think my friends who raved about it (Ira and Emily) must have been drunk before they even got there. But then you go inside. There's a nice big room with a nice bar and tables set up with inlaid checkers/chess boards and an overall nice ambiance. But the real jewel is out a side door to a HUGE beer garden

A Genius Idea, Really

Why aren't there more of these around?! These are a great idea! While I was in England many years ago, I spent much time in beer gardens and pubs. I've been told they're all over the place in Germany, too. I mean: a garden, what's not to like about a garden? Some nice chairs and tables (check, check). Drinking good beer (excellent). Add a lovely garden for such an activity, and you've got yourself a thing of beauty. Oh, it just makes such perfect sense it hurts. It's like those old Reeses chocolate and peanut butter mishap commercials from the '80s.

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somehow concealed from the road. Tasting some fine beers and having a brat for lunch before the wedding on a cloudless, mid-70s, Michigan afternoon was easily the highlight of my visit to Kalamazoo.

Logging vacation

I had taken off from work on both Friday and Monday. I keep my logbook on my computer at work and usually when I get into work on Monday mornings, I download my readings and then enter them into my excel logbook by hand. With 4 days worth of data to enter on Tuesday morning, and a decent amount of work to get going on, I quickly declared that I was going to take a 1 week vacation from logging my blood sugars. It's been nice, but there's been so many times that I've instictually searched for my excel logbook to be open somewhere on my computer after testing my blood sugar, that I'm pretty sure getting back to my usual habits come Monday morning won't be much of a problem.

Admin

Based on two comments on a previous post (one from Shannon, and one from my brother-in-law, Manus) and a conversation I had with my friend, Cori, I've come to realize that my nifty little pop-up asides are being missed by a few readers. There's a couple of reasons this may be happening:

1. You have javascript disabled on your browser. If this is why you're missing these asides, I apologize, because I don't know how to make my content user-friendly for those who have turned javascript capabilities off on the browsers.
2. You are viewing the page on a small screen (a laptop, for example) and/or at a low resolution. If that is the case, know that each bold word on my page serves as a link. If there isn't a little icon next to the bold word indicating that the link will take you away from my blog, then the link *should* pop open an aside to the right of the main content. And occasionally, I put more content in the asides than in the main content. You may have to scroll to the right to see this content if you fall into this category.
   

And finally, I've got some details

mea culpa

When I was talking to the doc about my CGMS results, I complained about the design of the shower bag for the monitor similar to what I pointed out in a previous post. She informed me that there's actually a double pocket there, that I was supposed to undo the sticky seal, and the insert monitor up and over into the pocket (kinda like a non-zip-lock sandwich bag) and then just close up the sticky seal where the stereo wire hangs out. The sticky was not designed to hold monitor in the bag upside down. Thus it crashed onto the shower floor on me. I'm thinking I'll take 60% of the blame on this one and split the other 40% between poor design and my lack of proper vision without my glasses in the shower (that's the best excuse I can come up with for why I missed this "double pocket").

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Errata

And just because I'm anal and detail oriented, I'd like to point out that in another previous post I repeatedly refered to the "cannula" that we pumpers have living under our skins as a "catheter". While I think the difference is mostly semantic, it seems strange that after learning the word "cannula" and reading it thousands of times over the past 5 years of pumping insulin, I would start calling it a "catheter". Catheter (in my mind, at least) has such an unpleasant connotation. I think, however, that I did actually refer to it as a "catheter" when that freak-show physician put me on the spot.

Sorry to bore you with details from a detail-oriented freak. Just crossing my "I"s and dotting my "T"s.

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to clear up.

A Few Firsts

This past weekend I had a handful of firsts:

• I went to the beach

  Well...

  Obviously not a true "first" but certainly the first time in a long time. It's easily been several years since I've last spent the day at the beach. Four, maybe? Five? I don't know.
  
  We used to go every year with another family for a week's vacation to the beach when I was a kid and we loved it. We'd spend all day, everyday at the beach and most of that time swimming in the ocean.
  
  I'm not sure why, but for some reason I've all but lost my enjoyment for the beach and ocean. I attribute a portion of this to my pump and the hassle it is to spend a day on the beach with one, but then there's the crowds, the heat, the jelly-fish and seaweed, the sunburn, the shlepping of crap from car to beach, the hot sand, the gluttony and overload of the senses of boardwalks, etc., etc.
  
  Perhaps I'm just becoming a crotchety old man before my time, I don't know.
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  on Saturday for a day trip with my in-laws


• I tried out an "unteathered

  A True First

  I'd waffled back and forth about whether or not I'd try this for a day at the beach. Then I got an email from my CDE, Gary, at the last minute with a nice, simple strategy to try out and I figured "what the heck!"
  
  I took 10 units of Lantus on Saturday morning, and set up an alternative basal pattern (yet another first -- and I've been pumping for 5 years!). The Lantus basically gave me 0.4u/hr of coverage which allowed me to be off my pump from 9am to 6pm. During the night, I reconnected to supplement that 0.4u/hr coverage from the Lantus with more basal insulin.
  
  I'd like to be able to report that it was a complete success, but I'm not sure I'd go that far. But I will say this: it was nice. I was able to disconnect for most of the day (only reconnecting twice for some beach-blanket-snack-attacks) and swim in the ocean for as long as I wanted without having to even think about needing to get back on my pump. That right there is not to be under valued, though. It really was nice not having to worry about that, so I could focus on avoiding the stray jelly fish instead.
  
  For the most part, my blood sugar was low and stable during the day, but the evening was another story. I can't completely tell, however, whether it was the different basal program or the pizza, beer, and the large soft-serve ice cream that botched it all up. I had a low before the pizza dinner then didn't extend my bolus for the pizza, then had another low after dinner, which lead to me ordering a large soft-serve ice cream cone with jimmies/sprinkles (depending on where you're from), which I couldn't finish.
  
  Rookie mistakes, I realize - I'm going to blame it on all the sun.
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  " regime


• I used that little plastic dohicky

  Do these things have a name?

  I really have no idea what these things are called, and for the longest time, I didn't even know what they were.
  
  Like most tasks in life, I usually end up with "extra parts" when I'm finish and don't think much of it when that happens (this usually happens when assembling a new grill or some Ikea furniture, but it is something to be seriously concerned about if it happens when I'm changing the oil in my car or something important like that).
  
  I must say, I liked this little thing. And I found that when I forgot to put it on after my last beach-blanket-snack-attack and then went back into the ocean after that, I found re-attaching to the pump for dinner to be a bit difficult. Like the pieces just didn't fit together as nicely.
  
  I'm not sure whether there was salt-water to blame or not, but I'm just sayin'.
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  that covers one's insertion site


• I had a strange interaction

  True Story

  So, we arrive at the beach in two cars (Meg, her parents and myself in one, and Bro & Sis in-law with three nephews in the other). The plan is that we'll get dumped at the beach, haul our stuff to a location amongst the crowds, and the cars will be parked by brother-in-law and father-in-law, respectively.
  
  I help get us situated on the beach and then lather myself up with sun block (though I did a less-than-perfect job and you can actually see a finger outline on my right arm: normal pale skin with coverage, burnt red skin where missed).
  
  I go up to the top of the beach to look out for Bro & Pa in-law as they come back from parking the cars.
  
  I'm standing on a bench, with my ultra-white, desk-job, hasn't seen the sun in 3 years torso serving as a beacon for the parkers to find me.
  
  Father-in-law shows up, we chat and I point out where we are on the beach, and I tell him that I'll wait for brother-in-law.
  
  I scan the crowds some more.
  
  I then turn back toward the beach and there's a grown man (easily in his 40s) about a foot away (clearly in my personal space) staring at me.
  
  I look down at him, he looks up at me and after a beat, he points and says:
  
  "What's that little white disk on your side for?"
  "Ummmm, it's for an insulin pump."
  "So there's a needle under there?"
  "Ummmm, yeah, a catheter, but I'm not hooked up to the rest of the pump that delivers the insulin."
  He continues to stare.
  "Do you have some familiarity with insulin pumps?" I ask to break the awkward silence.
  "No. But I am a physician."
  
  And with that he just turned and walked away from me. People are weird, I swear.
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  with a stranger re: my insertion site


• I had my insertion site fall out

  Not really a first,
  but only the 2nd or 3rd time, maybe

  I'm not sure whether it was because of all the salt-water, or the extra twisting that was required to detach and re-attach from the site.
  
  I had had a stubborn low on Sunday morning (again not sure whether it was lingering Lantus cause or not) and I was pretty sure I had over treated it.
  
  I got home and took a nap in the afternoon and when I woke up I had a pretty high reading, so I just figured all that treatment for the low was catching up with me and I bolused to correct.
  
  A little while later, I went to take the dog to the park and I was feeling icky. I don't know what made me check it, but I randomly pulled up my shirt to look at the site and sure enough the catheter was hanging out and bent against the skin and there was a puddle of insulin where, I'm sure, that correction bolus landed.
  
  I hustled back to the house, put a new pump site in (with Novolog this time (more on that below)), checked my blood sugar (440 mg/dl), pounded water for a few hours, checked ketones (small-medium) and waited for everything to get back to normal (which took a good 4 hours and a few more corrections to do so).
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  on Sunday afternoon


• And I'm trying out Novolog

  I was reading

  I'm not sure how I came across this, but I read this, which describes the action difference between Novolog and Humalog. This states that Novolog may peak slightly faster than Humalog AND that it's more stable in the heat and less likely to spoil than Humalog. Both sounded like good things, and since there have been times that I've noticed a decently long lag between my bolus and my blood sugars starting to drop, I figured why not test it out to see what happens.
  
  I'm pretty sure that when I was on an MDI regime I was using Novolog in my pens, so I'm guessing it shouldn't be all that different. I'm not sure whether I'll notice any differences or not. We shall see.
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  in my pump rather than good ol' Humalog

Hope you all had nice weekends.
I'll keep you posted on the Novolog vs. Humalog comparison/contrast...

A Dilemma

Okay, so I have a dilemma (and yes, I'm hoping you can help me with it).

First some back-story:
I've mentioned this before, but back in May I hastily decided that I was going to participate in the JDRF Walk to Cure Diabetes on the National Mall. Two weeks before the walk, I sent out an email to friends and family, and another to coworkers asking for their support. I was absolutely stunned, astonished, and genuinely awed that in a little over two weeks, I'd received more then $3,300 in pledges to JDRF on my behalf. I received such and overwhelming amount of support (both financial and plain ol' "go get 'em!" emotional support too) from my friends, family, and colleagues that I was on the verge of tears for a solid two weeks.

Every time someone wrote me an email, or stopped by my office to drop off a donation, I was just filled with gratitude and hope. And as I wrote to many of them in my response to their kindness: "From the bottom of my malfunctioning pancreas, I cannot thank you enough." I really don't have words to sufficiently express my gratitude.

This is all good, right? (Happy, Happy, Joy, Joy abounds).

So here's where the dilemma comes in and messes with my head:

Just last week I received a catalog from JDRF notifying me that because I raised between $2,500 and $4,999 I am eligible to select an item from the "Gold Level" in their catalog as a "small token of [their] appreciation" and as a "reward for my achievement."

How nice.

But, Holy Shit!

Look at the stuff

A Biased Sample

This only a sample of the items available. Not included are items that I'm not really interested in such as jewelry, a metal detector (though that might be cool), or a sculpture of an eagle.
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they offer in the "Gold

Copper, Bronze, Silver, Gold, and...

Yup, there's actually a "Platinum Level" for those raising over $5,000, but I honestly haven't even looked to see what kinds of ridiculous items are offered there.
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Level" of their gift catalog:

• An Apple iPod^® Nano
• Emerilware^® 10-pc. Stainless Cook Set
• A Samsung^® DVD Recorder
• A Samsung^® 20" FlatScreen TV
• A Stamina Magnetic Recumbant Exercise Bike

And that's not all...

There's More!

There's actually some stuff in the print catalog that was sent to me in the mail that is not in the on-line catalog. I presume all items are available for selection.
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• A Brother^® 5-in-1 fax, printer, copier, scanner (that's only a 4-in-1 by my count, but I'm not going to quibble)
• A set of Bose^® 201 Series V Speakers
• A Daewoo

  I Really Don't Know

  They have a Daewoo TV listed in the print catalog and a Samsung TV listed in the on-line catalog. Not sure why. I also don't know why "Daewoo" isn't "Daewoo^®" either.
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  20" Stereo Color TV
• A Cambridge SoundWorks^® Clock Radio
• A Samsonite^® Legacy™ 4-pc Luggage Set

Now, I'm not a very materialistic person by any means, but this is some nice stuff, which gets me thinkin':

• "Doesn't offering this stuff increase the overhead

  I Sure Hope

  I expect that all of these items are given to JDRF at a DEEP discount and that someone has done a significant bit of cost-benefit analysis on the offering of gift incentives for raising money. I really hope it doesn't impact their costs significantly, but then again what does "significantly" mean? I'll pretend that they have the right mix of gifts selected such that the gift-to-fundraising elasticity implies that not offering them they would actually decrease the amount of money raised in a given year. If there's any research on this, I'd certainly like to see it.
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  costs of JDRF?"
• "Do these gifts really act as significant incentives

  Perhaps

  I can imagine to get people who are not *directly* affected with diabetes to raise money for the cause, this type of incentive plan might work. But for people who have diabetes themselves, or parents who have children with diabetes, I'm pretty sure this is the furthest from their minds when they decide they're going to join the cause.
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  for people to get out and raise money for the organization?"
• "Would I feel comfortable, being a diabetic myself and feeling pretty strongly about the need to cure diabetes and the importance of JDRF's funding research as a means to that goal, actually selecting one of these gifts for myself?"
• "How would someone who made a donation to JDRF on my behalf feel about my receiving just a "small token" for THEIR

  Don't Hesitate

  If you happen to be one such friend/family member/colleague who made a contribution to JDRF on my behalf, please feel free to chime in here and let me know what you thing about this. Inquiring minds want to know.
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  generosity?"

Basically, it boils down to this:

1. I have diabetes
2. I am extremely lucky to have a kind, thoughtful, and generous group of friends and family
3. I had the audacity to actually ask them for their financial help to raise money to cure diabetes
4. They delivered in spades
5. I get a prize

I don't know... it just seems... wrong. But then I'm tempted by the material goods (whichh, I suppose, is the point). You can almost imagine the devil and angel on either of my shoulders, right?

The kind folks at JDRF did put a sentence in the letter that states: "As always, however, you can choose to forgo your prize and donate the value back to the JDRF and the Walk to Cure Diabetes."

Woe is me... I hate having a conscience sometimes.

What are your thoughts on this?